Matthieu Hein

Hyperarousal during sleep in untreated primary insomnia sufferers: A polysomnographic study

Because some evidence favors the hyperarousal model of insomnia, we sought to learn more about the dynamics of this phenomenon during sleep. Polysomnographic data from 30 normative subjects and 86 untreated primary insomnia sufferers recruited from the database of the sleep laboratory were studied for whole nights and in terms of thirds of the night. Untreated primary insomnia sufferers had an increased sleep latency and excess of WASO, together with a deficit in REM and NREM sleep during the entire night. In terms of thirds of the night, they presented a major excess of WASO during the first and last thirds of the night but an excess of lesser importance during the middle third. A deficit in SWS was found during the first third of the night, but for REM, the deficit was present during both the first and last thirds. Primary insomnia sufferers had no SWS or REM deficit during the second third of the night. We found that the hyperarousal phenomenon occurs mainly during the sleep-onset period of the first and last thirds of the night and is less important during the middle third. These results open new avenues for understanding the pathophysiology of primary insomnia.

Similar polysomnographic pattern in primary insomnia and major depression with objective insomnia: a sign of common pathophysiology?

BackgroundOur aim is to verify empirically the existence of a major depressed subgroup with a similar polysomnographic pattern as primary insomnia, including at rapid eye movement sleep level.MethodsThe polysomnographic data from 209 untreated individuals (30 normative, 84 primary insomnia sufferers, and 95 major depressed patients with objective insomnia) who were recruited retrospectively from the Erasme hospital database were studied for the whole night and thirds of the night.ResultsPrimary insomnia sufferers and major depressed patients with objective insomnia exhibit a similar polysomnographic pattern both for the whole night (excess of wake after sleep onset, deficit in slow-wave sleep/rapid eye movement sleep, and non-shortened rapid eye movement latency) and thirds of the night (excess of wake after sleep onset at first and last third, deficit in slow-wave sleep in first third, and deficit in rapid eye movement sleep in first and last third), including at rapid eye movement sleep level.ConclusionIn our study, we demonstrated that major depressed patients with objective insomnia showed a similar polysomnographic pattern as primary insomnia, including at rapid eye movement sleep level, which supports the hypothesis of a common pathophysiology that could be hyperarousal. This opens new avenues for understanding the pathophysiology of major depression with objective insomnia.

Hyperarousal during sleep in untreated, major depressed subjects with prodromal insomnia: A polysomnographic study

In primary insomnia, specific dynamics of hyperarousal are evident during the night. Similarly, in major depression, many elements also favor of the presence of hyperarousal. Thus, it would be interesting to investigate if hyperarousal presents the same dynamic in major depression. Polysomnographic data from 30 healthy controls, 66 patients with major depression and prodromal insomnia, and 86 primary insomnia sufferers recruited from the sleep laboratory database were studied for whole night and thirds of the night. Insomnia sufferers and patients with depression exhibit a similar polysomnographic pattern both for whole night (increased sleep latency and WASO and reduced SWS and REM) and thirds of night (increased WASO at first and last thirds, reduced SWS in first third, and reduced in REM in first and last third). No alterations were detected during the second third of the night. Just as in primary insomnia, the hyperarousal phenomenon is found mainly in major depression with prodromal insomnia during the sleep-onset period and the first and last thirds of the night, but lesser during the second third of the night. These specific dynamics of hyperarousal may aid in the understanding of the particular relationship between insomnia and depression.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects

BackgroundSeveral studies have investigated the prevalence and risk factors of insomnia in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of insomnia sufferers.MethodsData from 1311 insomnia sufferers who were recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as the cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.ResultsThe prevalence of moderate to severe obstructive sleep apnea syndrome in our sample of insomnia sufferers was 13.88%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower maintenance insomnia complaint, presence of metabolic syndrome, agexa0≥xa050 & <65xa0years, agexa0≥xa065xa0years, BMI ≥ 25 & <30xa0kg/m2, BMI >30xa0kg/m2, and CRP >7xa0mg/L were significant risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.ConclusionModerate to severe obstructive sleep apnea syndrome is a common pathology in insomnia sufferers. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in major depression: a observational and retrospective study on 703 subjects

BackgroundSeveral studies have investigated the prevalence and risk factors of depression in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in major depression. The aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of individuals with major depression.MethodsData from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in major depression.ResultsThe prevalence of moderate to severe obstructive sleep apnea syndrome in major depression is 13.94%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower insomnia complaint, presence of metabolic syndrome, ageu2009≥u200950xa0years, BMI >30xa0kg/m2, ferritin >300xa0μg/L, CRP >7xa0mg/L and duration of sleep ≥8xa0h were significant risk factors of moderate to severe obstructive sleep apnea syndrome in major depression.ConclusionModerate to severe obstructive sleep apnea syndrome is a common pathology in major depression. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in major depression.

Prevalence and risk factors of type 2 diabetes in major depression: A study on 703 individuals referred for sleep examinations

BACKGROUNDnSeveral studies have investigated the prevalence and risk factors of depression in individuals with type 2 diabetes. However, few studies have investigated the prevalence and risk factors for type 2 diabetes in major depression.nnnOBJECTIVEnThe aim of this study was to examine the prevalence and risk factors of type 2 diabetes in a large sample of individuals with major depression.nnnMETHODSnData from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. Only individuals with a diagnosis of type 2 diabetes according to the diagnostic criteria of the American Diabetes Association were included in the diabetes group. Logistic regression analyses were conducted to examine clinical and demographic risk factors of type 2 diabetes in major depression.nnnRESULTSnThe prevalence of type 2 diabetes in major depression is 21.2%. Multivariate logistic regression analysis revealed that male sex, high blood pressure, hypertriglyceridemia, BMI ≥30kg/m², age ≥50 years, sleep duration <6.5 hours, C-reactive protein ≥4.5mg/L, Beck Depression Inventory >12, and apnea-hypopnea index ≥5/h were significant risk factors of type 2 diabetes in major depression.nnnCONCLUSIONnType 2 diabetes is a common condition in major depression. In this subpopulation, most of the risk factors for type 2 diabetes are reversible, which justifies better prevention and management of this disorder to avoid its negative consequences.

Prevalence and risk factors of excessive daytime sleepiness in insomnia sufferers: A study with 1311 individuals

BACKGROUNDnSeveral studies have investigated the prevalence and risk factors of excessive daytime sleepiness in the general population. However, few studies have investigated these in the particular subpopulation of insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of excessive daytime sleepiness in a large sample of insomnia sufferers.nnnMETHODSnData from 1311 insomnia sufferers with age≥18years and recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. A score>10 on the Epworth scale was used as the cut-off score for excessive daytime sleepiness. Logistic regression analyses were conducted to examine clinical and demographic risk factors of excessive daytime sleepiness in insomnia sufferers.nnnRESULTSnThe prevalence of excessive daytime sleepiness in our sample was 45.61%. Multivariate logistic regression analysis revealed that non-use of Z-drugs, non-use of Trazodone alone or in combination, body mass index≥25 & <30kg/m2, body mass index≥30kg/m2, age≥18 & <40years, age≥40 & <65years, Beck depression inventory score≥5 & <16, Beck depression inventory score≥16, apnea-hypopnea index≥15/h, and use of selective serotonin reuptake inhibitors were significant risk factors of excessive daytime sleepiness in the subpopulation of insomnia sufferers.nnnCONCLUSIONnExcessive daytime sleepiness is a common complaint for individuals with insomnia. In this subpopulation, most of the risk factors for excessive daytime sleepiness are reversible, which justifies better management of this complaint to avoid its negative consequences.

Prevalence and risk factors of excessive daytime sleepiness in major depression: A study with 703 individuals referred for polysomnography

BACKGROUNDnTo date, few studies have investigated the prevalence and risk factors of excessive daytime sleepiness (EDS) in major depression. Thus, the aim of the present study was to examine the prevalence and risk factors of EDS in a large sample of individuals with major depression.nnnMETHODSnData from 703 individuals with major depression were retrospectively collected from the sleep laboratory research database of Erasme Hospital for analysis. A score ofu202f>u202f10 on the Epworth Sleepiness Scale was used as the cut-off for EDS. Logistic regression analyses were conducted to examine the clinical and demographic risk factors of EDS in major depression.nnnRESULTSnThe prevalence of EDS in our sample was 50.8%. Multivariate logistic regression analysis revealed that the following were significant risk factors of EDS in major depression: non-use of short to intermediate half-life benzodiazepine receptor agonists, BMIu202f≥u202f25u202fkg/m², ageu202f<u202f60 years, C-reactive proteinu202f>u202f7u202fmg/L, Beck Depression Inventory scoreu202f≥u202f16, atypical depression, apnea-hypopnea indexu202f≥u202f15/h, and use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.nnnLIMITATIONSnTo evaluate EDS, we used the Epworth Sleepiness Scale, which only allows for a subjective measure of daytime sleepiness.nnnCONCLUSIONnEDS is a common symptom in individuals with major depression. In this subpopulation, interventions are possible for most risk factors of EDS, which justifies improved management of this symptom to avoid its negative consequences.

Objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are risk factors for high blood pressure in individuals with insomnia: A study in 1272 individuals referred for sleep examinations

INTRODUCTIONnGiven conflicting data in the literature, the aim of this study was to examine the risk of high blood pressure (HBP) associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of individuals with insomnia.nnnMETHODSnDemographic and polysomnographic data from 1272 individuals with insomnia recruited from the research database of the sleep laboratory of Erasme Hospital were analyzed. HBP status was defined by the presence of one of the following: self-report at interview of either a physicians diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140xa0mm Hg or an average diastolic blood pressure ≥90xa0mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of HBP associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in individuals with insomnia.nnnRESULTSnThe prevalence of HBP in individuals with insomnia is 30.03%. After adjustment for major confounding factors associated with HBP, multivariate logistic regression analysis revealed that short sleep duration (<5xa0h), severely reduced sleep efficiency (<65%), high sleep fragmentation (sleep fragmentation index ≥18/h), and long-term use of short or intermediate half-life benzodiazepine receptor agonists were significant risk factors for HBP in individuals with insomnia.nnnCONCLUSIONnIn individuals with insomnia, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of HBP. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and HBP.

Prevalence and risk factors of type 2 diabetes in insomnia sufferers: A study on 1311 individuals referred for sleep examinations

BACKGROUNDnSeveral studies have investigated the particular relationship between insomnia and type 2 diabetes. However, few studies have investigated the prevalence and risk factors for type 2 diabetes in insomnia sufferers. The aim of this study was to examine the prevalence and risk factors of type 2 diabetes in a large sample of insomnia sufferers.nnnMETHODSnData from 1311 insomnia sufferers recruited from the research database of the Erasme Hospital sleep laboratory were analyzed. Only individuals with a diagnosis of type 2 diabetes according to the diagnostic criteria of the American Diabetes Association at admission were included in the diabetes group. Logistic regression analyses were conducted to examine clinical and demographic risk factors of type 2 diabetes in insomnia sufferers.nnnRESULTSnThe prevalence of type 2 diabetes in insomnia sufferers is 21.13%. Multivariate logistic regression analysis revealed that significant risk factors of type 2 diabetes in insomnia sufferers were as follows: being male, Z-drugs use, high blood pressure, hypertriglyceridemia, alcohol consumption of ≥4 units/day, BMI ≥25 & <30xa0kg/m2, BMI ≥30xa0kg/m2, age ≥50 years, C-reactive protein ≥4.5xa0mg/L, a sleep duration of <6.5xa0h, apnea-hypopnea index ≥15/hour, periodic limb movements index ≥26/hour, and severe complaints of early morning awakening.nnnCONCLUSIONnType 2 diabetes is a common pathology in insomnia sufferers. In this subpopulation, most of the risk factors for type 2 diabetes are reversible, which justifies better prevention and management of this pathology in order to avoid its negative consequences.